SFD (9909-014)57151 Medinah
9909-014
LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000) of Division 3 of the Business and
Professionals Code, and my License is in full force and effect.
License # Lic. Class Exp.. Date
701039 13 .- 131/31/2(
'ate Signature of Contractor
OWNER -BUILDER DELL"ARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( )' I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) 1, as owner of the property, am exclusively contracting with licensed
contractors to construct the `project (Sec. 7044, Business & Professionals
Code).
( ) I am exempt under Section , B&P.C. for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of ,perjury one of the following declarations:
( ) I have and will maintain a certificate of consent to self -insure for workers'.
compensation, as provided for by Section 3700. of the Labor :Code, for the,
performance of the work for which this permit is issued.
( ) I have and will maintain workers' compensation insurance, as required by
`Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation .insurance carrier & policy no. are:
Carrier STATE FUND Policy No. , 935«98-()001236
(This section need not be completed if the permit valuation is for $100.00 or less).
() I certify that in the performance of the. work for which this permit is issued,
I shall not employ any person in any. manner so as to become subject to the
workers' compensation laws of California, and agree that if4 should become
subject to the workers' compensation provisions of Section"3700 of the Labor
Code, I shall forthwith comply with those.p;owsions. /
Date: Applicant / I V{ ' /A /
Warning: Failure to secure Workers' Compensation coveriige is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, -in
addition to the cost of compensation, *damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees.
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to ,the conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit Work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, and State laws relating to the building
construction, and hereby authorize representatives of this City to enter upon
the above-mentioned property for inspecttiion,purposes.
gnature (Owner/Agent) Date iL-- . ,
- 0 BUILDING PERMIT PERMIT#
DATE VALUATION LOT '_ TRACT
$21786440 2 28410.2/1
JOB SITE
APN
ADDRESS 57:al_ d MINA
, 71&_180__0.18
—
OWNER
CONTRACTOR /DESIGNER /ENGINEER
MryCOWC-M. IJ1C
'IMMS MMT[OVSJO INC
750 BUT STE, 3140
787401 F HIGHWAY 171
SAND71✓C.sO CA 92101
LA. QLAW A Ch 92253
(619)857.9191. CIL# 4972
r
USE OF PERMIT
B—NOLE FAiv1 U Y DVM-MJ0
Sia0. LOT 74, PLAN 2C, PERMIT'DOES NOT •INCLUDE BLOCK WALL OR
P006 75% REDUCTION ON PLAN CHFCK FEE OR MULTIPLE ISSUtR./ NCE:
OF SAM1, PLAN TYPE,
CUSTOM CONSTRUCTION 2,572.06 8F
PORC HIPATIC11 432.00 Sr
OARAGFJC.ARPORT 600.00 8F
FSMAM CO&T OF C0N'S1:RUCfl0N
217,136+4.40
i='Ii2w2' 7fX 5t+I1AtsAawy
CONSTRUCTION FEF 101.00O-418-000 $11052.50
PIAN CHECK FEE 101-000-439-318 $215.39
?+lIEC:1 i AN1G,gL, FE 19 101.000421-300 $98.90
ELECTRICAL FEE 101-000-420-000 $I39.52
PLUMBMG FEE 101.0007419-000 $178.00
STRONG MOTION FEE • RESIN 101-000-241-000 $21.79
GRADING FI'EE 1,01-000-4,23-000 t20.00
t .
ART IN PUBLIC PLACES • RM11: 707-000253-00f5
DW ELOPER IMPACT FEE
BUB -TOTAL CO10TrRUC7Z0N AND PLAN C;PTECTi
3,65 .36
1 u9 FR 2-PAM :SES
$0.00
TOTAL PEWMT17AS MY, NOW
RECEIPT
DATE
By;,/., %
DATE FINALED
INSPECTOR
ill
INSPECTION RECORD
OPERATION
DATE
I INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING
APPROVALS
MECHANICAL APPROVALS
Set Backs
4
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing
Compressor
Insulation amVents
Fireplace P.L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath
/
Drywall - Int. Lath
ez
Final
Final l
BLOCKWALL APPROVALS
POOLS - SPAS
steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
/
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K. for Finish Plaster
Sewer Lateral
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
p/
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final
Utility Notice (Perm)
COMMENTS:
DEC -01-2000 16:44 WESTERN INSULATION _ 909 666 8786 P.15/17
TERN INSULATION, INC O
4911 1.8ffi8m Street, %YEPBIQ6, Callf mla 92301
TeL (909) 686.8766 Fax (909) 686-8786
E931R ATION CERTIFICATE
r t .
THIS IS TO CERTIFY THAT INSULATION HAS BEEN INSTALLED IN CONFORMANCE WITH
THE CURRENT ENERGY REGULATION, CALIFORNIA ADMINISTRATIVE CODE, TITLE 24,
STATE OF CALIFORNIA, IN THE BUILDING LOCATED AT:,
TRACT / PHASE: PGA WEST - AUGUSTA
LOT # 24
SITE ADDRESS . - 57-161 MEDINAH LA QUINTA, CA
...------ ---------------------------------.
EXTERIOR WALLS:
MANUFACTURER: JOHNS MANVILLE THICKNESS: 3 1/2 " R -VALUE: R-15
'Calu - BATTS SLOW
MANUFACTURER: JOHNS MANVILLE THICKNESS: 13" R- VALUE: R-38
GENERAL CONTRACTOR TRANSWEST HOSING
BY: 1 „
TITLE; -
DATE:
INSULATION G0NIRACTOR: WESTERN INSULATION, INC.
LICENSE NUMBER 81278
BY: ,
TITLE: PRODUCTION MA AGEPC
DATE DECEMBER 1, 20010
Certificate of. 6cc,upancy,OL
City. of La' Quints
Buildin and Safet Departmewt C��M aFg Y_
This Certificate issued pursuant to the requirements of Section 109 of the Uniform Bui/ding Code,
certifying that, at the time of issuance, this structure was in compliance with the various ordinances
of the City regulating building construction or use. For the following:
BUILDING ADDRESS: 57-151 MEDINAH
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9909-014
Occupancy Group: R=3 Type of Construction: VN Land "Use Zone: RL
Owner of Building: MCCOMIC.'SEOKTOP LLC Address: 750 B ST STE 3140
City: SAN -DIEGO, CA., 92101
`rte By: DANIEL P. CRAWFORD A.
Date: 2/14/01
Building Official '
- POST IN A CONSPICUOUS PLACE